巴西亚马逊地区多重疾病的患病率、模式及相关决定因素：一项横断面研究。
Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study.
作者信息
Araujo Maria Elizete A, Silva Marcus T, Galvao Tais F, Nunes Bruno P, Pereira Mauricio G
机构信息
Post-Graduate Program Health Sciences, University of Brasilia, Brasilia, Brazil.
Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Brazil.
出版信息
BMJ Open. 2018 Nov 3;8(11):e023398. doi: 10.1136/bmjopen-2018-023398.
OBJECTIVES
To estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus.
DESIGN
Cross-sectional population-based study.
SETTING
Interviews conducted between May and August of 2015 in eight cities that compose the metropolitan region of Manaus, Amazonas, Brazil.
PARTICIPANTS
4001 adults aged ≥18 years.
PRIMARY OUTCOME MEASURES
Multimorbidity, measured by the occurrence of ≥2 and ≥3 chronic diseases, was the primary outcome. The associated factors were investigated by calculating the prevalence ratio (PR) obtained by Poisson regression, with robust adjustment of the variance in a hierarchical model. A factor analysis was conducted to investigate multimorbidity clusters.
RESULTS
Half of the interviewees were women. The presence of a chronic disease was reported by 57.2% (95% CI 56.6% to 59.7%) of the interviewees, and the mean morbidity was 1.2 (1.1-1.2); 29.0% (95% CI 27.6% to 30.5%) reported ≥2 morbidities and 15.2% (95% CI 14.1% to 16.4%) reported ≥3 chronic conditions. Back pain was reported by one-third of the interviewees. Multimorbidity was highest in women, PR=1.66 (95% CI 1.50 to 1.83); the elderly, PR=5.68 (95% CI 4.51 to 7.15) and individuals with worse health perception, PR=3.70 (95% CI 2.73 to 5.00). Associated factors also included undergoing medical consultations, hospitalisation in the last year, suffering from dengue in the last year and seeking the same healthcare service. Factor analysis revealed a pattern of multimorbidity in women. The factor loading the most strength of association in women was heart disease. In men, an association was identified in two groups, and lung disease was the disease with the highest factorial loading.
CONCLUSION
Multimorbidity was frequent in the metropolitan region of Manaus. It occurred most often in women, in the elderly and in those with worse health perception.
目的
评估多重疾病的患病率，并确定巴西玛瑙斯大都市区成年人群中与之相关的因素。
设计
基于人群的横断面研究。
背景
2015年5月至8月间，在巴西亚马逊州玛瑙斯大都市区的8个城市进行了访谈。
参与者
4001名年龄≥18岁的成年人。
主要观察指标
以≥2种和≥3种慢性病的发生情况衡量的多重疾病是主要观察指标。通过计算泊松回归得出的患病率比（PR）来研究相关因素，并在分层模型中对方差进行稳健调整。进行因子分析以研究多重疾病聚类情况。
结果
一半的受访者为女性。57.2%（95%置信区间56.6%至59.7%）的受访者报告患有慢性病，平均患病数为1.2（1.1 - 1.2）；29.0%（95%置信区间27.6%至30.5%）报告有≥2种疾病，15.2%（95%置信区间14.1%至16.4%）报告有≥3种慢性病。三分之一的受访者报告有背痛。多重疾病在女性中最为常见，PR = 1.66（95%置信区间1.50至1.83）；在老年人中，PR = 5.68（95%置信区间4.51至7.15），在健康认知较差的个体中，PR = 3.70（95%置信区间2.73至5.00）。相关因素还包括接受医疗咨询、去年住院、去年患登革热以及寻求同一种医疗服务。因子分析揭示了女性多重疾病的一种模式。在女性中关联强度最大的因子是心脏病。在男性中，在两个组中发现了关联，肺病是因子载荷最高的疾病。
结论
多重疾病在玛瑙斯大都市区很常见。它最常发生在女性、老年人以及健康认知较差的人群中。
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